My favorite books about medical ethics and end-of-life

This is a classic book.

It is probably the most influential book in the field of medical ethics since the field was established during the 1960s.

I use this book and its invoked Georgetown Mantra of Bioethics, which includes the principles of beneficence, non-maleficence, autonomy, and justice, in all my medical ethics courses, and refer to this book often when I'm writing about medical ethics and end-of-life concerns.

Its guiding principles are relevant today as they were when the book was written. 

I invited Tom Beauchamp to one of the conferences I organised. Tom subsequently contributed a chapter to my edited volume Medical Ethics at the Dawn of the 21st Century (New York: New York Academy of Sciences, 2000), Vol. 913 of the Annals.

He also invited me to present my book at the Kennedy Institute of Ethics, Georgetown University. When I was teaching at Johns Hopkins I also enjoyed meeting his life partner, Ruth Faden, who is also a brilliant medical ethicist.

Edmund (Ed) D. Pellegrino was a man of many qualities and achievements.

He was one of the forefathers of medical ethics. He was a learned Catholic. He was hailed as a “complete physician” among “a handful of other high-profile physician leaders of the twentieth century.

In a long and remarkable career that spanned over 55 years of research and scholarship, Pellegrino published more than 550 scholarly books and articles.

In For the Patient's Good, the authors discuss the notion of beneficence as a guiding principle in medical ethics. They examine the content of the concept of 'patient good' from ethical, philosophical, and practical aspects, speaking about the duties of the medical professionals to their patients.

Ed and I used to meet during my visits to Washington. We had lengthy conversations about medical ethics, philosophy, religion (Catholicism, Judaism), and education.

He was the keynote speaker in one of the conferences I organised. I greatly appreciated him. We kept in touch up until his death in 2013.

Like Pellegrino, Daniel (Dan) Callahan is also one of the forefathers of the field of medical ethics. 

A prolific author, Dan published 47 books and some 800 articles and blogs. Dan is also the co-founder of the Hastings Center in New York, one of the leading research centers on medical ethics in the world. In many ways, his vision established medical ethics as a legitimate field of studies.

In Setting Limits, Callahan suggests the concept of a “full biographical life span,” meaning the point at which it can be said that a person has lived a complete, fulfilling, whole life. He does not determine a specific age but suggests a range — late seventies, early eighties, which in his opinion is equivalent to a natural, complete life cycle. 

Callahan claims that today medical technology can extend life beyond the point that he believes is sensible and worthwhile. He deliberates what can be done to avoid such a result.

I was fortunate to visit the Hastings Center twice, in 1994 and 1999. Dan and I fiercely and candidly debated his ideas, articulated in his books The Troubled Dream of Life, What Kind of Life, and Setting Limits, as well as my ideas discussed in the two books that I was writing at that time: The Right to Die with Dignity and Euthanasia in the Netherlands.

Although we did not share the same views on end of life, I always appreciated his wisdom and liked him as a person. I have consulted with Dan on some of my later projects, and the two of us kept in touch up until Dan’s death in 2019.

In 1991, Dworkin taught at Oxford a seminar titled “Abortion, Euthanasia and Dementia”.

Until then, I never paid too much attention to these subjects, not more than any lay person with general knowledge. I attended the seminar simply because Dworkin delivered it.

This was the most interesting and thought-provoking seminar I have ever attended in my life. It opened my interest in medical ethics, a field that is still one of my preoccupations.

Dworkin was writing at that time Life’s Dominion. Each week he would circulate a chapter of his book, to be discussed in the following week.

We were some twelve students in class; each of us read and commented on the chapters. There was a very lively exchange and fierce debates.

Again, while I disagreed with some of Dworkin’s arguments, I could not but appreciate the force of his reasoning. After that seminar, I decided to embark on research on one of the three seminar themes: Euthanasia.

Life’s Dominion has become the center of some of my counter-arguments as Dworkin believed that euthanasia should also be granted for people who suffer from dementia whereas I oppose euthanasia and restrict acts that aim to shorten life to competent patients who voluntarily wish to end their lives.

The book brings together two contradictory viewpoints.

While Jackson argues that we should legalise assisted suicide in order to enable ‘good death’ and honour patients’ wishes, Keown opposes such a legislation, thinking that voluntary euthanasia and physician-assisted suicide are gravely unethical and what we need to do is to improve care, not to offer death.

This is an excellent exchange of ideas that I have used in my classes on end-of-life concerns.

John Keown and I meet in Washington every once and a while. Although we disagree on whether physician-assisted suicide should be offered, we agree on the need to preserve the dignity of the person as well as on many other fundamental issues.

I greatly appreciate John’s scholarship.